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Under ‘Medicaid reform,’ rural Iowans need to learn not to get sick


Under ‘Medicaid reform,’ rural Iowans need to learn not to get sick

Sep 30, 2023 | 8:01 pm ET
By Dave Nagle
Under ‘Medicaid reform,’ rural Iowans need to learn not to get sick
"Medicaid reform" that relies on of kicking people off the program is endangering rural hospitals. (Photo via Getty Images)

People who live in the metro areas of Iowa may be unaware, but good citizens who reside in rural Iowa are painfully cognizant local hospitals are in desperate financial condition and losing the fight to remain in operation.

The good news, if we can label it as such, is the problem is nationwide. The number of rural hospitals closing is staggering and only going to accelerate. More than 600 rural hospitals nationally are facing closure, according to the Center for Healthcare Quality and Payment Reform.

In the face of these developments, our governor and her conservative backers have found steps to reverse this process and are quickly seeking to implement them. The first step is to remove from the rolls those who obtained Medicaid coverage in the middle of the pandemic. Nationally, there is an effort to remove patients who can now obtain private insurance coverage or who have the means to risk going without. This is termed “Medicaid reform.” 

(For those of you who have trouble recognizing sarcasm, this is a friendly notice.)

The “reformation” has already commenced. More than 5.5 million Americans have been dropped from coverage even before our governor’s purging of patients in Iowa gets into full swing. Depending on a voter’s political perception, this is good news or grounds to pause. That is because, of the 5.5 million people cut from Medicaid coverage, 26% were determined to be no longer eligible. However, 74% were eliminated because of “procedural” problems. Adults, and their children, are losing coverage because they didn’t reply to the form in time, there were mistakes made in evaluating their application, or they simply weren’t notified.

In addition, as reported by Amy Goldstein in the Washington Post, “potentially millions of children have been improperly dropped from Medicaid rolls across many states.” Federal officials have ordered 12 states to immediately review the computer process and to correct the errors, if found.

In Iowa, nearly 28,000 people were disenrolled starting in April.  Earlier this month, the federal government announced that it was working to reenroll thousands of people who were cut off even though they were still qualified. However, it’s unlikely that everyone who qualifies will be able to navigate the red tape needed to stay enrolled.

Iowa’s search and destroy mission will be conducted by the private companies that administer our Medicaid program (called managed care organizations), whose compensation is structured to reward cuts in program costs. They will mail out to all individuals and families in Iowa on the program a 10-day notice, and if the individuals fail to respond within 10 days, they are dropped.

The downside for communities is that frequently the only source of payment for hospitals is Medicaid. The reimbursement rate is inadequate but at least some offset to care facilities’ cost of treatment. When the uninsured, non-Medicaid, patient shows up, the hospital, by its mission statement, still treats the needy. When a Medicaid patient is treated, all Iowa hospitals place them on a health training program to lessen the chances of their condition getting worse, helping them to live a healthier lifestyle. The same program will not apply to the uninsured.

Being Irish, all this reminds me of the British response to the Potato Famine of the mid-19th century. England’s answer was not to assist the Irish, because they would become dependent upon the aid. Now the pesky lower-income, disabled, and elderly citizens of our state who, just like the Irish who wouldn’t learn not to eat, these cantankerous people will not learn not to get sick. Not only that, but they will also take their children to the emergency room. Both parent and child will just be sicker, and the hospital still will just not be paid.

The governor’s other solution is not better. We are going to lower the standard of medical care for rural Iowans by permitting lesser-trained people to take the place of licensed physicians. They will see a doctor only by telemedicine, if needed.

The American Medical Association has issued a statement that declares this step misguided. According to the AMA, this approach will result in misdiagnosis, worse outcomes, and higher costs in the range of millions of dollars. This also raises the question as to why we should have two standards of care, one for those who live in metro areas and a lower one for residents of farmland?

The solution is simple. All rural, low-income people should move to the land of the Golden Kingdom, Polk County, where the Republicans see no problem. Heck, once there, they can visit the company that used to reside in their town before being lured away, with government assistance, to Des Moines. Then, they can get a job at a local convenience store or grocery. The people of Boone should have first option.